HomeMy WebLinkAbout20130677.tiffCOLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of: Weld Month of : February 2013
SECTION I: GENERAL INFORMATION
Telephone Calls
541
Office (Public Contacts)
275
Home Visits
Outreach Visits (i.e. NH...)
1
Community Events/Forums
Request for Medals
4
Operation Recognition
_
Request for Medical Treatment Records
21-4142
26
Correspondence Received
88
Correspondence Written
115
Information and Referral/Inquiries
120
Other (i.e: VCAA Notice Response)
29
State Benefit(s)
6
Request for Military Records & Corrections
SF -180
22
DD 149
2
DD 293
NA 13075
Other ( )
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Ap ointed Representative:
21-22
CVA
28
21-22
Other
1
Claims for SC Entitlement:
21-526
(SC - New/)
28
21-4138
(SC - Informal Claim)
21-4138
(SC - New Issue)
2
21-4138
(SC - Reopen)
21-4138
(SC - Increase)
21-4138
(SC - Seoonaary/Aggray.:.on)
21-4138
(SC - Reinstatement)
21-4138
_(SC w/ IU
21-8940
(IU)
21-4192
(IU - Employer)
21-4138
(SMC)
21-686c
Non Service Connected Pension:
21-526
2
21-527
686c
21-526/527 w! A&A
21-4138 (Reinstatement)
EVR (Any)
21-8416
5655
Request for Waivers/Compromise:
21-4138
2
5655 (FSR)
Dependent Indemnity Compensation
(DIC)
21-534
w/ Accrued Benefits
Death Pension / Widows Pension
21-534
3
w/ Accrued Benefits
Request for VA Healthcare
10-10 EZ
23
10-10 EZ-R
10-583
1
10-10d iCHAMPVA - Dependents)
10-7959a (CHAMPVA)
10-7959C (CHAMPVA - Insurance Cert
Vocational Rehabilitation
28-1900 CH 31
28-1900 (Independent Living Program)
Educational Assistance Programs
POST 9/11 CH 33
5
VRAP
4
VN Era GI CH 34
22-5490 CH 35
Sel Reservist NG CH 1607
21-674
Miscellaneous Claims
21-8678 (Clothing Allowance)
21-4502 (Auto Grant / Adaptive Equipment)
26-4555 (Housing Grant)
10-0103 (HISA Grant)
Medicaid Application Assistance
SSA Application Assistance
Other (Specify)
Other (Specify)
Other (Specify)
C VA -26 (Revised 9/1/2006)
2013-0677
ti/4Z-161
SECTION II (Continued):
Burial Allowance
21-530
40-1330
21-2008
1
1
VA Home Loan
26-1800
26-1817
3
Homeless Veterans Claims Flied
SC
NSC
2
Incarcerated Veterans
21-4193 Release/Reinstatement
2
21-4138 (Apportionment)
Appeals
NOD
VA 9
Claims for Insurance
29 -357
29-4364
29-336 (Designation of Beneficiary)
21-4125 (Claim for Lump Sum Payment)
Requests wl VTF (Grant), M Vets Assisted
Rental Assistance
4
Utilities Assistance
Prescription Assistance / Other Medical
Food
14
Transportation
2
Clothing
Other
DRO Election
Review
4
Hearing
3
SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER
I hereby certify, the above captioned monthly report is true and accurate. I have been paid the following
amount(s) for the month of FEBRUARY . 2012 from WELD
Salary _ $4,270.91
Expenses
Office Space
Telephone $283.31
Office Supplies $59.79
Trave'
Training Conference
Other
Other
Total _ $4,614.01
/3
(Signature -6f County Veterans Service Officer) (Date)
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordance with CRS 28-
ereby certify the accuracy of the Report (CVA-26, revised 9/1/20i 2011)
F. Garcia, Chair
MAR 1 1 2013
County Commissioner or Designee of
County
Date
This certification, submitted monthly, property signed and executed, will be considered as application for the
monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue.
This form is to be submitted by the 15th day of the following month. Mail to:
Colorado Division of Veterans Affairs
Attention: Director Bill Conroy
1355 S. Colorado Blvd., Suite 113, Bldg C
Denver, CO 80222 CVA-26 (Revised 9/1/2006)
170/3 - o� 77
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